Provider Demographics
NPI:1770646853
Name:VILLENA, MARIA JOANNA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JOANNA
Last Name:VILLENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87738
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7738
Mailing Address - Country:US
Mailing Address - Phone:910-339-1446
Mailing Address - Fax:877-500-1463
Practice Address - Street 1:1750 METROMEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-339-1446
Practice Address - Fax:877-500-1463
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCI39044Medicare UPIN
2044965Medicare ID - Type Unspecified